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Shrestha S, Sapkota S, Teoh SL, Kc B, Paudyal V, Lee SWH, Gan SH. Comprehensive assessment of pain characteristics, quality of life, and pain management in cancer patients: a multi-center cross-sectional study. Qual Life Res 2024; 33:2755-2771. [PMID: 39105961 PMCID: PMC11452497 DOI: 10.1007/s11136-024-03725-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings. OBJECTIVES The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients. METHODS This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale. RESULTS Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%. CONCLUSION In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia.
| | - Simit Sapkota
- Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal
- Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia
| | - Bhuvan Kc
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- College of Public Health, Medical, and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental 21 Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well Being Cluster, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia
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Dong Y, Zuo Y. A meta-analysis of ultrasound-guided stellate ganglion block on the quality of recovery after cancer surgery. Medicine (Baltimore) 2024; 103:e39559. [PMID: 39331907 PMCID: PMC11441944 DOI: 10.1097/md.0000000000039559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Pain is a prevalent symptom among patients with cancer, significantly impacting their health and quality of life. Stellate ganglion block (SGB) has been employed as a diagnostic, prognostic, or therapeutic intervention for various pain syndromes. This systematic review and meta-analysis aimed to examine the effects of ultrasound-guided SGB on postoperative recovery quality and other functional indicators following cancer surgery. METHODS Data were sourced from PubMed, PEDro, CINAHL, SportDiscus, and Scopus. Inclusion criteria followed the population-intervention-comparison-outcome principle. The evaluation process involved meticulous screening, judicious data extraction, and rigorous assessment of trial methodology quality, conducted independently by 2 researchers. Standardized mean differences with corresponding 95% confidence intervals were pooled using either a random-effects or fixed-effects model. RESULTS Ultrasound-guided SGB exhibited potential for improving postoperative pain scores after cancer surgery (RR, 7.81 [95% confidence interval (CI), 5.43-10.19]), reducing daily consumption of oxycodone (RR, 0.78 [95% CI, -1.37 to 2.93]) and pregabalin (RR, -22.26 [95% CI, -91.37 to 46.85]), enhancing physical health (RR, -2.50 [95% CI, -11.00 to 6.00]) and mental health (RR, -5.10 [95% CI, -13.45 to 3.25]), and influencing mean arterial pressure (RR, -10.60 [95% CI, -17.92 to -3.27]), mean pulmonary artery pressure (RR, -1.02 [95% CI, -2.83 to 0.79]), heart rate (RR, -11.18 [95% CI, -17.91 to -4.46]), and central venous pressure (RR, -0.05 [95% CI, -1.53 to 1.43]) as effective treatment modalities. CONCLUSION This systematic review and meta-analysis suggests that ultrasound-guided SGB therapy is effective in reducing pain levels and improving mobility and quality of life compared to conventional treatments. Therefore, clinicians should consider administering SGBs to patients with chronic cancer pain, emphasizing sensory exercise to achieve a balance between movement and rest.
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Affiliation(s)
- Yuhui Dong
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Pina LTS, Rabelo TK, Borges LP, S S Gonçalves V, Silva AS, Oliveira MA, S S Quintans J, Quintans Júnior LJ, Scotti L, Scotti MT, da Silva Júnior EG, Douglas Melo Coutinho H, Guimarães AG. Antihyperalgesic effect of γ-terpinene complexed in β-cyclodextrin on neuropathic pain model induced by tumor cells. Int J Pharm 2024; 662:124538. [PMID: 39079594 DOI: 10.1016/j.ijpharm.2024.124538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/16/2024] [Accepted: 07/26/2024] [Indexed: 08/03/2024]
Abstract
Neuropathic pain is a high-intensity pain that can be caused by compression, transection, injury, nerve infiltration and drug treatment of cancer. Furthermore, drug therapy has low clinical efficacy, many adverse effects and remission of painful symptoms. In this way, natural products derived from plants constitute a promising therapeutic alternative. Therefore, the aim of this study was to evaluate the antihyperalgesic effect of γ-terpinene (γ-TPN) e γ-terpinene in β-cyclodextrin inclusion complexes (TPN/CD) on neuropathic pain induced by tumor cells. Complexation extended the effect time for another 5 h and daily treatment for six days with γ-TPN (50 mg/kg, p.o.) and γ-TPN/β-CD (50 mg/kg, p.o.) significantly reduced (p < 0.001) the mechanical hyperalgesia induced by the administration of 2x106 sarcoma cells 180 in the around the sciatic nerve. In addition, the Grip and Rota-rod techniques demonstrated that there was no interference on the muscle strength and motor coordination of the animals, suggesting that the compound under study does not have central nervous system depressant effects at the doses used. Molecular docking studies demonstrate favorable binding energies between γ-TPN and β-CD, and alpha-2 adrenergic, glutamatergic, opioid and cholinergic receptors. Thus, this study demonstrates the potential of terpinene complexation in controlling neuropathic pain induced by tumor cells.
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Affiliation(s)
- Lícia T S Pina
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Thallita K Rabelo
- Harquail Centre for Neuromodulation, Sunnybrook Helth Sciences Centre, University of Toronto, Ontario, Canada
| | - Lysandro P Borges
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Vitória S S Gonçalves
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Akleyton S Silva
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Marlange A Oliveira
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Jullyana S S Quintans
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | | | | | | | | | - Adriana G Guimarães
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Ameenudeen S, Waseem M, S H. Identification of potential phytochemicals and their inhibitory effect on the PERK receptor mediated UPR pathway for neuronal disease regulation: an in silico insight. J Biomol Struct Dyn 2024; 42:7838-7846. [PMID: 37528651 DOI: 10.1080/07391102.2023.2242495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
The endoplasmic reticulum (ER) has been considered as the key site of protein biosynthesis and maturation in the eukaryotic cell. In recent years, the sequence at the N-terminal region of translated protein has shown a particular emphasis as a signal responsible for site-specific translocation mediated by post-translational modification. Once the native conformation is not achieved, the degradation pathway is activated, and therefore the restoration of the homeostasis of ER function in UPR pathway is initiated. One of the transmembrane proteins, PKR-like ER kinase (PERK) plays a key role in the activation of UPR through the inhibition of the translation process, thus preventing the cells from apoptosis due to chronic ER stress. Dysregulation of the neuronal proteostasis often results in neuronal dysfunction and its crucially associated neurodegenerative diseases or its manifestation of neuropathic pain. The correlation between ER stress and its associated signaling cascade, namely UPR, is well established in context of neuropathological modifications. This furthermore suggests that the proteins of the signaling cascade such as PERK can serve as a potential target during the onset of neuronal damage. The aim of this study was to identify the potential phytocompounds by evaluating the physicochemical properties, Lipinski screening, ADMET and toxicity properties of the selected phytocompounds by using SwissADME, MolInspiration and pKCSM webservers, which could establish a comparatively better affinity and binding energy than the control drug as GSK2606414 in set up the treatment of the neuronal diseases through molecular docking via PyRx and validating their structural stability through simulation using the Sybyl software for over100ns.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Shabnam Ameenudeen
- School of Life Sciences, B. S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, India
| | - Mohammad Waseem
- School of Pharmacy, University of Maryland, College Park, MD, USA
| | - Hemalatha S
- School of Life Sciences, B. S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, India
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Mulvey MR, Paley CA, Schuberth A, King N, Page A, Neoh K. Neuropathic Pain in Cancer: What Are the Current Guidelines? Curr Treat Options Oncol 2024; 25:1193-1202. [PMID: 39102168 PMCID: PMC11416366 DOI: 10.1007/s11864-024-01248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/06/2024]
Abstract
OPINION STATEMENT Neuropathic cancer pain is experienced by 30-40% of patients with cancer. It significantly reduces quality of life and overall wellbeing for patients living with and beyond cancer. The underlying mechanisms of neuropathic pain in patients with cancer are complex and involve direct tumour involvement, nerve compression or infiltration, chemotherapy and/or radiotherapy-induced nerve damage, or post-surgical complications. It is crucial for healthcare professionals to assess and manage neuropathic cancer pain effectively. There is increasing recognition that standardisation of neuropathic pain assessment leads to tailored management and improved patient outcomes. Pain management strategies, including medication, interventional analgesia, physical and complementary therapy, can help alleviate neuropathic pain and improve the patient's comfort and quality of life.
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Affiliation(s)
- Matthew R Mulvey
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds Level, 10 Worsley Building, Clarendon Road, Leeds, LS2 9LN, UK.
| | - Carole A Paley
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds Level, 10 Worsley Building, Clarendon Road, Leeds, LS2 9LN, UK
| | - Anna Schuberth
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds Level, 10 Worsley Building, Clarendon Road, Leeds, LS2 9LN, UK
| | - Natalie King
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds Level, 10 Worsley Building, Clarendon Road, Leeds, LS2 9LN, UK
| | - Andy Page
- Academic Unit of Palliative Care, St Gemma's Hospice, Leeds, UK
| | - Karen Neoh
- Academic Unit of Palliative Care, St Gemma's Hospice, Leeds, UK
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Kim S, Sebastian M, Cooper M. Anaesthesia for primary bone sarcoma. BJA Educ 2024; 24:288-295. [PMID: 39099752 PMCID: PMC11293499 DOI: 10.1016/j.bjae.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- S.C.P. Kim
- Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - M.P. Sebastian
- Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - M.A. Cooper
- Royal National Orthopaedic Hospital NHS Trust, London, UK
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Miki T, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Yamashita M, Uchida S, Noda T, Ueno K, Hotta K, Maekawa E, Sasaki J, Yamaoka-Tojo M, Matsunaga A, Ako J. Cancer history and physical function in patients with cardiovascular disease. Heart Vessels 2024; 39:654-663. [PMID: 38578318 DOI: 10.1007/s00380-024-02379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024]
Abstract
Both cancer and cardiovascular disease (CVD) cause skeletal muscle mass loss, thereby increasing the likelihood of a poor prognosis. We investigated the association between cancer history and physical function and their combined association with prognosis in patients with CVD. We retrospectively reviewed 3,796 patients with CVD (median age: 70 years; interquartile range [IQR]: 61-77 years) who had undergone physical function tests (gait speed and 6-minute walk distance [6MWD]) at discharge. We performed multiple linear regression analyses to assess potential associations between cancer history and physical function. Moreover, Kaplan-Meier curves and Cox regression analyses were used to evaluate prognostic associations in four groups of patients categorized by the absence or presence of cancer history and of high or low physical function. Multiple regression analyses showed that cancer history was significantly and independently associated with a lower gait speed and 6MWD performance. A total of 610 deaths occurred during the follow-up period (median: 3.1 years; IQR: 1.4-5.4 years). The coexistence of low physical function and cancer history in patients with CVD was associated with a significantly higher mortality risk, even after adjusting for covariates (cancer history/low gait speed, hazard ratio [HR]: 1.93, P < 0.001; and cancer history/low 6MWD, HR: 1.61, P = 0.002). Cancer history is associated with low physical function in patients with CVD, and the combination of both factors is associated with a poor prognosis.
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Affiliation(s)
- Takashi Miki
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan.
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Division of Research, ARCE Inc., Sagamihara, Kanagawa, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Kazuki Hotta
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Tanyel Saraçoğlu T, Akbaş F, Onay M, Bilir A, Güleç S. Prolonged Effect of Repetitive Erector Spinae Plane Block in Reducing Thoracic Pain Caused by Lung Cancer. Cureus 2024; 16:e57130. [PMID: 38681332 PMCID: PMC11055569 DOI: 10.7759/cureus.57130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Pain significantly affects the quality of life of lung cancer patients. We aimed to evaluate the effect of the erector spinae plane block (ESPB) on pain in these patients. METHODS We reviewed the medical records of patients with primary lung and bronchial cancer who experienced refractory pain in the thoracic region and underwent repeated ESPBs (three blocks at 24-hour intervals) between 2019 and 2020 in this single-center retrospective study. Visual analog scale (VAS) scores recorded before the procedure and on the first day (first day after the third block) and the first and third months of follow-up in 43 patients were analyzed. Results: The study population consisted of 31 male and 12 female patients, with a mean age of 56.7 years. The mean pre-procedure VAS score was 8.9±0.8, which showed a significant decrease on the first day (2.9), first month (3.6), and third month (4.6) of the follow-up. Four patients experienced minor complications (pain at the procedure site and hypotension); however, no major complications were observed. CONCLUSION We observed a prolonged effect of repeated ESPBs for ≥3 months. The block efficacy decreased with time; however, an approximately 50% reduction in the VAS score persisted even in the third month. Repetitive ESPBs may be regarded as a straightforward, safe, and replicable intervention to complement medical treatment and diminish the need for opioids in managing lung cancer-related pain.
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Affiliation(s)
- Tuba Tanyel Saraçoğlu
- Department of Pain Management, Başakşehir Çam ve Sakura City Hospital, İstanbul, TUR
| | - Fırat Akbaş
- Department of Pain Management, Gaziantep City Hospital, Gaziantep, TUR
| | - Meryem Onay
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University, Eskişehir, TUR
| | - Ayten Bilir
- Department of Pain Management, Eskisehir Osmangazi University, Eskişehir, TUR
| | - Sacit Güleç
- Department of Pain Management, Eskisehir Osmangazi University, Eskişehir, TUR
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Moloney NA, Lenoir D. Assessment of neuropathic pain following cancer treatment. Anat Rec (Hoboken) 2024; 307:309-319. [PMID: 36700536 DOI: 10.1002/ar.25161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 01/27/2023]
Abstract
Neuropathic cancer pain (NCP) is prevalent affecting up to 58% of those with persistent pain following cancer treatment. Neuropathic pain can develop from malignancy, after neural tissue insult during surgery and/or exposure to radiation or neurotoxic agents used as part of cancer treatment regimens. Pain following cancer treatment is commonly under-treated and one barrier identified is poor recognition of pain and inadequate assessment. Recognition of the presence of NCP is important to inform pain management, which is challenging to treat and warrants the use of specific treatments to target neuropathic mechanisms. In this review, approaches for screening and classifying NCP are described. These include screening questionnaires and the application of the updated neuropathic pain grading system in a cancer context. The evidence from neuropathic pain related assessments in cancer populations is provided and highlighted under different neuropathic pain grades. Recommendations for assessment in practice are provided.
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Affiliation(s)
- Niamh A Moloney
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Dorine Lenoir
- Pain in Motion International Research Group, Ghent, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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Singh S, Dhiraaj S, Shamshery C, Singh S, Singh A, Kumar RA, Mishra P. Incidence of Different Characters of Neuropathic Pain in Cancer Patients Coming to Tertiary Care Centre in North India Over A Period of 1 Year - An Observational Study. Indian J Palliat Care 2024; 30:27-33. [PMID: 38633685 PMCID: PMC11021066 DOI: 10.25259/ijpc_199_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/29/2023] [Indexed: 04/19/2024] Open
Abstract
Objectives Pain is classified as nociceptive, neuropathic, or nociplastic. Neuropathic pain presents as variable phenotypes (characters) based on specific aetiology and pathophysiology. This study aimed to find out among cancer patients the incidence of different phenotypes of neuropathic pain and form specific phenotypic clusters based on the underlying neurophysiology and association of sensory profile with various organ systems - A prospective observational study. Materials and methods The Institutional Ethical Committee clearance (IEC code: 2020-49-MD-EXP-15) https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=44886&EncHid=88651.15716&userName=CTRI/2020/09/027964 approval was obtained. After written and informed consent, patients of age group 18-80 years, registering in the pain and palliative outpatient department or radiotherapy department with complaints of pain and not taking any anti-neuropathic pain medications, were enrolled. They were assessed using Leeds assessment of neuropathic symptoms and signs (LANSS) pain score, and a score of >12 was eligible for assessment of neuropathic pain phenotypes. Results Out of 210 cancer patients complaining of pain, a neuropathic component with LANSS >12 was found in 73 (34.76%). The most predominant phenotypes, allodynia> tingling> pricking = burning, were found in 72.60%, 56.16%, and 43.84% of patients, respectively. Phenotypes were clustered into Nodes 1 and 2 based on clinically significant separation of phenotypes. Node 1 had neuropathic pain of spontaneous origin found predominantly in gastrointestinal tract (GIT) and genitourinary tract (GUT) cancers. Node 2 had stimulus-evoked negative and positive characters which occurred in head and neck, thoracic, and spinal metastatic cancers. Conclusion Careful patient assessment reveals the incidence of neuropathic pain in 34.76%; allodynia and tingling astable the most prominent phenotypes. Broadly, sensory characters were clustered into spontaneous and stimulus-evoked sensations with GIT and GUT cancers presenting with Node 1 symptoms.
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Affiliation(s)
- Shipra Singh
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Dhiraaj
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chetna Shamshery
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shalini Singh
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anjali Singh
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajput Abhishek Kumar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Pereira AFM, Cavalcante JS, Angstmam DG, Almeida C, Soares GS, Pucca MB, Ferreira Junior RS. Unveiling the Pain Relief Potential: Harnessing Analgesic Peptides from Animal Venoms. Pharmaceutics 2023; 15:2766. [PMID: 38140106 PMCID: PMC10748172 DOI: 10.3390/pharmaceutics15122766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The concept of pain encompasses a complex interplay of sensory and emotional experiences associated with actual or potential tissue damage. Accurately describing and localizing pain, whether acute or chronic, mild or severe, poses a challenge due to its diverse manifestations. Understanding the underlying origins and mechanisms of these pain variations is crucial for effective management and pharmacological interventions. Derived from a wide spectrum of species, including snakes, arthropods, mollusks, and vertebrates, animal venoms have emerged as abundant repositories of potential biomolecules exhibiting analgesic properties across a broad spectrum of pain models. This review focuses on highlighting the most promising venom-derived toxins investigated as potential prototypes for analgesic drugs. The discussion further encompasses research prospects, challenges in advancing analgesics, and the practical application of venom-derived toxins. As the field continues its evolution, tapping into the latent potential of these natural bioactive compounds holds the key to pioneering approaches in pain management and treatment. Therefore, animal toxins present countless possibilities for treating pain caused by different diseases. The development of new analgesic drugs from toxins is one of the directions that therapy must follow, and it seems to be moving forward by recommending the composition of multimodal therapy to combat pain.
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Affiliation(s)
- Ana Flávia Marques Pereira
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil;
| | - Joeliton S. Cavalcante
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil; (J.S.C.); (D.G.A.)
| | - Davi Gomes Angstmam
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil; (J.S.C.); (D.G.A.)
| | - Cayo Almeida
- Center of Mathematics, Computing Sciences and Cognition, Federal University of ABC, Santo André 09280-560, SP, Brazil;
| | - Gean S. Soares
- Delphina Rinaldi Abdel Azil Hospital and Emergency Room (HPSDRAA), Manaus 69093-415, AM, Brazil;
| | - Manuela B. Pucca
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University, Araraquara 14801-320, SP, Brazil;
| | - Rui Seabra Ferreira Junior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil;
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil; (J.S.C.); (D.G.A.)
- Center for Translational Science and Development of Biopharmaceuticals FAPESP/CEVAP, São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil
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12
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Løhre ET, Jakobsen G, Solheim TS, Klepstad P, Thronæs M. Breakthrough and Episodic Cancer Pain from a Palliative Care Perspective. Curr Oncol 2023; 30:10249-10259. [PMID: 38132380 PMCID: PMC10742182 DOI: 10.3390/curroncol30120746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/23/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023] Open
Abstract
Cancer pain intensity (PI) fluctuates, but the relationship between pain flares and background pain with respect to pain management is not settled. We studied how flare and background PIs corresponded with treatment results for background cancer pain. Patients admitted to an acute palliative care unit with average and/or worst PI ≥ 1 on the 11-point numeric rating scale were included. Average and worst PI at admission and average PI at discharge were collected. We examined how the difference and ratio between worst and average PI and average PI at admission, were associated with average PI development during hospitalization. Positive differences between worst and average PI at admission were defined as pain flares. Ninety out of 131 patients had pain flares. The reduction in average PI for patients with flares was 0.9 and for those without, 1.9 (p = 0.02). Patients with large worst minus average PI differences reported the least improvement, as did those with large worst/average PI ratios. Patients with pain flares and average PI ≤ 4 at admission had unchanged average PI during hospitalization, while those with pain flares and average PI > 4 experienced pain reduction (2.1, p < 0.001). Large pain flares, in absolute values and compared to background PI, were associated with inferior pain relief.
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Affiliation(s)
- Erik Torbjørn Løhre
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.T.L.)
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5007 Bergen, Norway
| | - Gunnhild Jakobsen
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.T.L.)
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Tora Skeidsvoll Solheim
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.T.L.)
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Pål Klepstad
- Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Morten Thronæs
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.T.L.)
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5007 Bergen, Norway
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13
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Macharia JM, Raposa BL, Sipos D, Melczer C, Toth Z, Káposztás Z. The Impact of Palliative Care on Mitigating Pain and Its Associated Effects in Determining Quality of Life among Colon Cancer Outpatients. Healthcare (Basel) 2023; 11:2954. [PMID: 37998446 PMCID: PMC10671794 DOI: 10.3390/healthcare11222954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Pain continues to be a significant problem for cancer patients, and the impact of a population-based strategy on their experiences is not completely understood. Our study aimed to determine the impact of palliative care on mitigating pain and its associated effects in determining the quality of life (QoL) among colon cancer outpatients. Six collection databases were used to perform a structured systematic review of the available literature, considering all papers published between the year 2000 and February 2023. PRISMA guidelines were adopted in our study, and a total of 9792 papers were evaluated. However, only 126 articles met the inclusion criteria. A precise diagnosis of disruptive colorectal cancer (CRC) pain disorders among patients under palliative care is necessary to mitigate it and its associated effects, enhance health, promote life expectancy, increase therapeutic responsiveness, and decrease comorbidity complications. Physical activities, the use of validated pain assessment tools, remote outpatient education and monitoring, chemotherapeutic pain reduction strategies, music and massage therapies, and bridging social isolation gaps are essential in enhancing QoL. We recommend and place a strong emphasis on the adoption of online training/or coaching programs and the integration of formal and informal palliative care systems for maximum QoL benefits among CRC outpatients.
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Affiliation(s)
- John M. Macharia
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Bence L. Raposa
- Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Dávid Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Str 14/B, 7400 Kaposvár, Hungary
| | - Csaba Melczer
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary;
| | - Zoltan Toth
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Zsolt Káposztás
- Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
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14
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Shi RJ, Ke BW, Tang YL, Liang XH. Perineural invasion: A potential driver of cancer-induced pain. Biochem Pharmacol 2023; 215:115692. [PMID: 37481133 DOI: 10.1016/j.bcp.2023.115692] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
Perineural invasion (PNI) is the process through which tumors invade and interact with nerves. The dynamic changes in the nerves caused by PNI may induce disturbing symptoms. PNI-related cancer pain in neuro-rich tumors has attracted much attention because the occurrence of tumor-induced pain is closely related to the invasion of nerves in the tumor microenvironment. PNI-related pain might indicate the occurrence of PNI, guide the improvement of treatment strategies, and predict the unresectability of tumors and the necessity of palliative care. Although many studies have investigated PNI, its relationship with tumor-induced pain and its common mechanisms have not been summarized thoroughly. Therefore, in this review, we evaluated the relationship between PNI and cancer-associated pain. We showed that PNI is a major cause of cancer-related pain and that this pain can predict the occurrence of PNI. We also elucidated the cellular and molecular mechanisms of PNI-induced pain. Finally, we analyzed the possible targets for alleviating PNI-related pain or combined antitumor and pain management. Our findings might provide new perspectives for improving the treatment of patients with malignant tumors.
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Affiliation(s)
- Rong-Jia Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery,West China Hospital of Stomatology (Sichuan University), No.14, Sec. 3, Renminnan Road, Chengdu 610041, Sichuan, China
| | - Bo-Wen Ke
- Laboratory of Anesthesiology & Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ya-Ling Tang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Pathology, West China Hospital of Stomatology (Sichuan University), No.14, Sec. 3, Renminnan Road, Chengdu 610041, Sichuan, China.
| | - Xin-Hua Liang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery,West China Hospital of Stomatology (Sichuan University), No.14, Sec. 3, Renminnan Road, Chengdu 610041, Sichuan, China.
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15
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Han J, Rolles M, Torabi F, Griffiths R, Bedston S, Akbari A, Burnett B, Lyons J, Greene G, Thomas R, Long T, Arnold C, Huws DW, Lawler M, Lyons RA. The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK. Support Care Cancer 2023; 31:531. [PMID: 37606853 PMCID: PMC10444652 DOI: 10.1007/s00520-023-07944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Public health measures instituted at the onset of the COVID-19 pandemic in the UK in 2020 had profound effects on the cancer patient pathway. We hypothesise that this may have affected analgesic prescriptions for cancer patients in primary care. METHODS A whole-nation retrospective, observational study of opioid and antineuropathic analgesics prescribed in primary care for two cohorts of cancer patients in Wales, using linked anonymised data to evaluate the impact of the pandemic and variation between different demographic backgrounds. RESULTS We found a significant increase in strong opioid prescriptions during the pandemic for patients within their first 12 months of diagnosis with a common cancer (incidence rate ratio (IRR) 1.15, 95% CI: 1.12-1.18, p < 0.001 for strong opioids) and significant increases in strong opioid and antineuropathic prescriptions for patients in the last 3 months prior to a cancer-related death (IRR = 1.06, 95% CI: 1.04-1.07, p < 0.001 for strong opioids; IRR = 1.11, 95% CI: 1.08-1.14, p < 0.001 for antineuropathics). A spike in opioid prescriptions for patients diagnosed in Q2 2020 and those who died in Q2 2020 was observed and interpreted as stockpiling. More analgesics were prescribed in more deprived quintiles. This differential was less pronounced in patients towards the end of life, which we attribute to closer professional supervision. CONCLUSIONS We demonstrate significant changes to community analgesic prescriptions for cancer patients related to the UK pandemic and illustrate prescription patterns linked to patients' demographic background.
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Affiliation(s)
- Jun Han
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
| | - Martin Rolles
- Population Data Science, Swansea University Medical School, Swansea, UK.
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea, UK.
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
| | - Bruce Burnett
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Giles Greene
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Rebecca Thomas
- Observatory and Cancer Analysis Team, Public Health Wales, Cardiff, UK
| | - Tamsin Long
- Observatory and Cancer Analysis Team, Public Health Wales, Cardiff, UK
| | - Cathy Arnold
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
- Data Services, University of Leeds, Leeds, UK
| | - Dyfed Wyn Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Mark Lawler
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
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16
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Taniguchi M, Yasukochi S, Yamakawa W, Tsurudome Y, Tsuruta A, Horiguchi M, Ushijima K, Yamashita T, Shindo N, Ojida A, Matsunaga N, Koyanagi S, Ohdo S. Inhibition of Tumor-Derived C-C Motif Chemokine Ligand 2 Expression Attenuates Tactile Allodynia in NCTC 2472 Fibrosarcoma-Inoculated Mice. Mol Pharmacol 2023; 104:73-79. [PMID: 37316349 DOI: 10.1124/molpharm.123.000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
Neuropathic pain associated with cancers is caused by tumor growth compressing and damaging nerves, which would also be enhanced by inflammatory factors through sensitizing nociceptor neurons. A troublesome hallmark symptom of neuropathic pain is hypersensitivity to innocuous stimuli, a condition known as "tactile allodynia", which is often refractory to NSAIDs and opioids. The involvement of chemokine CCL2 (monocyte chemoattractant protein-1) in cancer-evoked neuropathic pain is well established, but opinions remain divided as to whether CCL2 is involved in the production of tactile allodynia with tumor growth. In this study, we constructed Ccl2 knockout NCTC 2472 (Ccl2-KO NCTC) fibrosarcoma cells and conducted pain behavioral test using Ccl2-KO NCTC-implanted mice. Implantation of naïve NCTC cells around the sciatic nerves of mice produced tactile allodynia in the inoculated paw. Although the growth of Ccl2 KO NCTC-formed tumors was comparable to that of naïve NCTC-formed tumors, Ccl2-KO NCTC-bearing mice failed to show tactile pain hypersensitivity, suggesting the involvement of CCL2 in cancer-induced allodynia. Subcutaneous administration of controlled-release nanoparticles containing the CCL2 expression inhibitor NS-3-008 (1-benzyl-3-hexylguanidine) significantly attenuated tactile allodynia in naïve NCTC-bearing mice accompanied by a reduction of CCL2 content in tumor masses. Our present findings suggest that inhibition of CCL2 expression in cancer cells is a useful strategy to attenuate tactile allodynia induced by tumor growth. Development of a controlled-release system of CCL2 expression inhibitor may be a preventative option for the treatment of cancer-evoked neuropathic pain. SIGNIFICANCE STATEMENT: The blockade of chemokine/receptor signaling, particularly for C-C motif chemokine ligand 2 (CCL2) and its high-affinity receptor C-C chemokine receptor type 2 (CCR2), has been implicated to attenuate cancer-induced inflammatory and nociceptive pain. This study demonstrated that continuous inhibition of CCL2 production from cancer cells also prevents the development of tactile allodynia associated with tumor growth. Development of a controlled-release system of CCL2 expression inhibitor may be a preventative option for management of cancer-evoked tactile allodynia.
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Affiliation(s)
- Marie Taniguchi
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Sai Yasukochi
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Wakaba Yamakawa
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Yuya Tsurudome
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Akito Tsuruta
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Michiko Horiguchi
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Kentaro Ushijima
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Tomohiro Yamashita
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Naoya Shindo
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Akio Ojida
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Naoya Matsunaga
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Satoru Koyanagi
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
| | - Shigehiro Ohdo
- Department of Pharmaceutics (M.T., S.Y., W.Y., A.T., S.K., S.O.), Department of Bioanalytical Chemistry (N.S., A.O.), and Department of Drug Discovery Structural Biology (T.Y.), Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; Department of Glocal Healthcare Science (A.T., S.K.) and Department of Clinical Pharmacokinetics (N.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan; and Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan (Y.T., M.H., K.U.)
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17
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Bradley A, Boland JW. Effects of Opioids on Immune and Endocrine Function in Patients with Cancer Pain. Curr Treat Options Oncol 2023; 24:867-879. [PMID: 37145383 PMCID: PMC10271882 DOI: 10.1007/s11864-023-01091-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/06/2023]
Abstract
OPINION STATEMENT Opioids are an important treatment in managing cancer pain. Uncontrolled pain can be detrimental to function and quality of life. Common adverse effects of opioids such as sedation, constipation and nausea are well recognised, but opioid effects on the endocrine and immune systems are less apparent. The evidence for the immunomodulatory effects of opioids suggest that some opioids might be immunosuppressive and that their use might be associated with reduced survival and increased rates of infection in patients with cancer. However, the quality of this evidence is limited. Opioid-induced endocrinopathies, in particular opioid-induced hypogonadism, may also impact cancer survival and impair quality of life. But again, evidence in patients with cancer is limited, especially with regard to their management. There are some data that different opioids influence immune and endocrine function with varying outcomes. For example, some opioids, such as tramadol and buprenorphine, demonstrate immune-sparing qualities when compared to others. However, most of this data is preclinical and without adequate clinical correlation; thus, no opioid can currently be recommended over another in this context. Higher opioid doses might have more effect on immune and endocrine function. Ultimately, it is prudent to use the lowest effective dose to control the cancer pain. Clinical presentations of opioid-induced endocrinopathies should be considered in patients with cancer and assessed for, particularly in long-term opioid users. Hormone replacement therapies may be considered where appropriate with support from endocrinology specialists.
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Affiliation(s)
- Anna Bradley
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, HU6 7RX, UK.
- Hull York Medical School, University of York, York, YO10 5DD, UK.
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18
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Dan-feng Z, Jian-cheng R, Shu-zhen Z, Kun Z, Hong-zhi Y, Lian-sheng Y, Chun-zhi T. Enhanced acupuncture therapy for radiotherapy-related neuropathic pain in patients with gynecologic cancer: a report of two cases and brief review. Front Neurol 2023; 14:1163990. [PMID: 37351267 PMCID: PMC10282125 DOI: 10.3389/fneur.2023.1163990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/12/2023] [Indexed: 06/24/2023] Open
Abstract
As radiation therapy is increasingly utilized in the treatment of cancer, neuropathic pain (NP) is a common radiotherapy-related adverse effect and has a significant impact on clinical outcomes negatively. However, despite an improved understanding of neuropathic pain management, pain is often undertreated in patients with cancer. Herein, we reported two cases with radiotherapy-related neuropathic pain (RRNP) who presented a positive reaction to acupuncture. Patient 1 (a 73-year-old woman) with gynecologic cancer complained of burning and electric shock-like pain in the lower limb after radiotherapy. With the accepted combination of acupuncture and drugs, the pain was alleviated completely in 8 weeks. Patient 2 (a 64-year-old woman) accepted acupuncture in the absence of medication because of her inability to tolerate the adverse events of anticonvulsant drugs. She achieved remission of pain 4 weeks later. The results of this study showed that acupuncture might be promising for controlling the RRNP in patients with cancer, especially who were intolerant or unresponsive to medications.
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Affiliation(s)
- Zhou Dan-feng
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rong Jian-cheng
- Department of Rehabilitation, Jiangmen Central Hospital, Jiangmen, China
| | - Zheng Shu-zhen
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhang Kun
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Hong-zhi
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Lian-sheng
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tang Chun-zhi
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Yao J, Novosel M, Bellampalli S, Kapo J, Joseph J, Prsic E. Lung Cancer Supportive Care and Symptom Management. Hematol Oncol Clin North Am 2023; 37:609-622. [PMID: 37024385 DOI: 10.1016/j.hoc.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Lung cancer carries significant mortality and morbidity. In addition to treatment advances, supportive care may provide significant benefit for patients and their caregivers. A multidisciplinary approach is critical in addressing complications of lung cancer, including disease- and treatment-related complications, oncologic emergencies, symptom management and supportive care, and addressing the psychosocial needs of affected patients.
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Affiliation(s)
- Johnathan Yao
- Yale Internal Medicine-Traditional Residency Program, Department of Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208030, New Haven, CT 06520-8030, USA
| | - Madison Novosel
- Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Shreya Bellampalli
- Medical Scientist Training Program, Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jennifer Kapo
- Department of General Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208025, New Haven, CT 06520, USA
| | - Julia Joseph
- Yale Internal Medicine-Traditional Residency Program, Department of Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208030, New Haven, CT 06520-8030, USA
| | - Elizabeth Prsic
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208028, New Haven, CT 06520, USA.
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Sodergren SC, Johnson CD, Gilbert A, Darlington AS, Cocks K, Guren MG, Rivin Del Campo E, Brannan C, Christensen P, Chu W, Chung H, Dennis K, Desideri I, Gilbert DC, Glynne-Jones R, Jefford M, Johansson M, Johnsson A, Juul T, Kardamakis D, Lai-Kwon J, McFarlane V, Miguel IMC, Nugent K, Peters F, Riechelmann RP, Turhal NS, Wong S, Vassiliou V. International Validation of the EORTC QLQ-ANL27, a Field Study to Test the Anal Cancer-Specific Health-Related Quality-of-Life Questionnaire. Int J Radiat Oncol Biol Phys 2023; 115:1155-1164. [PMID: 36402360 DOI: 10.1016/j.ijrobp.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The European Organisation for Research and Treatment of Cancer (EORTC) health-related quality of life questionnaire for anal cancer (QLQ-ANL27) supplements the EORTC cancer generic measure (QLQ-C30) to measure concerns specific to people with anal cancer treated with chemoradiotherapy. This study tested the psychometric properties and acceptability of the QLQ-ANL27. METHODS AND MATERIALS People with anal cancer were recruited from 15 countries to complete the QLQ-C30 and QLQ-ANL27 and provide feedback on the QLQ-ANL27. Item responses, scale structure (multitrait scaling, factor analysis), reliability (internal consistency and reproducibility) and sensitivity (known group comparisons and responsiveness to change) of the QLQ-ANL27 were evaluated. RESULTS Data from 382 people were included in the analyses. The EORTC QLQ-ANL27 was acceptable, comprehensive, and easy to complete, taking an average 8 minutes to complete. Psychometric analyses supported the EORTC QLQ-ANL27 items and reliability (Cronbach's α ranging from 0.71-0.93 and test-retest coefficients above 0.7) and validity of the scales (particularly nonstoma bowel symptoms and pain/discomfort). Most scales distinguished people according to treatment phase and performance status. Bowel (nonstoma), pain/discomfort, and vaginal symptoms were sensitive to deteriorations over time. The stoma-related scales remained untested because of low numbers of people with a stoma. Revisions to the scoring and question ordering of the sexual items were proposed. CONCLUSIONS The QLQ-ANL27 has good psychometric properties and is available in 16 languages for people treated with chemoradiotherapy for anal cancer. It is used in clinical trials and has a potential role in clinical practice.
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Affiliation(s)
| | | | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | | | - Kim Cocks
- KCStats Consultancy, Cheshire, United Kingdom
| | - Marianne G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eleonor Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, Sorbonne University, Paris, France
| | | | | | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Hans Chung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Kristopher Dennis
- The Ottawa Hospital Cancer Centre, Ottawa, Canada; Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Duncan C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom
| | | | - Michael Jefford
- Departments of Medical Oncology and Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Mia Johansson
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Oncology, University of Gothenburg, Gothenburg, Sweden
| | - Anders Johnsson
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Therese Juul
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University of Patras Medical School, Patras, Greece
| | - Julia Lai-Kwon
- Departments of Medical Oncology and Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Vicky McFarlane
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Karen Nugent
- University Hospital Southampton, Southampton, United Kingdom
| | - Femke Peters
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Shun Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
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21
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Khaled ML, Tarhini AA, Forsyth PA, Smalley I, Piña Y. Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases. Cancers (Basel) 2023; 15:cancers15061884. [PMID: 36980770 PMCID: PMC10047692 DOI: 10.3390/cancers15061884] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Leptomeningeal disease (LMD) is a devastating complication caused by seeding malignant cells to the cerebrospinal fluid (CSF) and the leptomeningeal membrane. LMD is diagnosed in 5-15% of patients with systemic malignancy. Management of LMD is challenging due to the biological and metabolic tumor microenvironment of LMD being largely unknown. Patients with LMD can present with a wide variety of signs and/or symptoms that could be multifocal and include headache, nausea, vomiting, diplopia, and weakness, among others. The median survival time for patients with LMD is measured in weeks and up to 3-6 months with aggressive management, and death usually occurs due to progressive neurologic dysfunction. In melanoma, LMD is associated with a suppressive immune microenvironment characterized by a high number of apoptotic and exhausted CD4+ T-cells, myeloid-derived suppressor cells, and a low number of CD8+ T-cells. Proteomics analysis revealed enrichment of complement cascade, which may disrupt the blood-CSF barrier. Clinical management of melanoma LMD consists primarily of radiation therapy, BRAF/MEK inhibitors as targeted therapy, and immunotherapy with anti-PD-1, anti-CTLA-4, and anti-LAG-3 immune checkpoint inhibitors. This review summarizes the biology and anatomic features of melanoma LMD, as well as the current therapeutic approaches.
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Affiliation(s)
- Mariam Lotfy Khaled
- Metabolism and Physiology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo 12613, Egypt
| | - Ahmad A Tarhini
- Departments of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Peter A Forsyth
- Neuro-Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Inna Smalley
- Metabolism and Physiology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Yolanda Piña
- Neuro-Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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22
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Tuan J, Wang EH, De Leon JRC, Mendoza MJ, Varrassi G. Management of Acute Cancer Pain in Asia: An Expert Opinion on the Role of Tramadol/Dexketoprofen Fixed-Dose Combination. Cureus 2023; 15:e35770. [PMID: 37025730 PMCID: PMC10072166 DOI: 10.7759/cureus.35770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
Most patients experience acute cancer pain at some stage throughout their cancer journey. When inadequately managed, cancer pain has devastating consequences for the patient's quality of life. The suboptimal management of cancer pain in Asia is mainly driven by over-regulation and limited access to opioids. Concerns about adverse events and addiction have resulted in a negative perception of this group of drugs among physicians, as well as patients. There is a need to optimize the management of cancer pain across the region, through the provision of an alternative treatment option that is simple to prescribe, convenient to administer and well tolerated by patients, which will increase patients' compliance and good results. As recommended in many international guidelines, starting by the WHO analgesic ladder, cancer pain can be effectively managed with multimodal analgesia. Fixed-dose combinations (FDCs), in which two or more analgesic agents act synergistically to deliver a broad spectrum of pain relief, represent an effective and convenient option for delivering multimodal analgesia to patients with cancer pain. This is extremely well accepted by patients for several reasons. Any multimodal pharmacological approach to pain management should be based on the potentiality to block pain at different levels and to reduce the dosages of single analgesics, reducing their side effects. Hence, the use of NSAIDs, combined with other analgesics, is the general basis of multimodal pain management. If NSAIDs are combined with tramadol, a weak opioid that has per se a multimodal analgesic efficacy, it may be ideal. The tramadol/dexketoprofen FDC combines the centrally acting weak opioid with a peripherally acting NSAID to deliver rapid-onset, long-lasting analgesia, which has been proven efficacious and safe in the management of moderate-to-severe acute pain in the postoperative setting. This expert opinion explores the role of tramadol/dexketoprofen FDC in the management of patients with moderate-to-severe acute cancer pain. It is essentially based on the incredibly high amount of existing data on the use of the drug, and on the long-lasting experience of the experts in pain management of cancer patients participating in the advisory panel.
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23
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Belayneh M, Fainsinger R, Nekolaichuk C, Muller V, Bouchard S, Downar J, Galloway L, Ghosh S, Hawley P, Herx L, Kmet A, Lawlor P. Edmonton Classification System for Cancer Pain: Comparison of Pain Classification Features and Pain Intensity across Diverse Palliative Care Settings in Canada. J Palliat Med 2023; 26:366-375. [PMID: 36282783 DOI: 10.1089/jpm.2022.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The goal of the Edmonton Classification System for Cancer Pain (ECS-CP) is to create an international classification system for cancer pain. Previous studies reinforce the need for standardized training to ensure consistency across assessors. There is no universally accepted classification for neuropathic pain. Objectives: Our primary objective was to describe the prevalence of ECS-CP features in a diverse sample of advanced cancer patients, using assessors with standardized training. The secondary objectives were to: (1) determine the prevalence of neuropathic pain using the Neuropathic Pain Special Interest Group (NeuPSIG) criteria and (2) examine the relationship between specific predictors: ECS-CP features, age, Palliative Performance Scale, Morphine Equivalent Daily Dose (MEDD), setting, and pain intensity; and neuropathic pain. Methods: A total of 1050 adult patients with advanced cancer were recruited from 11 Canadian sites. A clinician completed the ECS-CP and NeuPSIG criteria, and collected additional information including demographics and pain intensity (now). All assessors received standardized training. Results: Of 1050 evaluable patients, 910 (87%) had cancer pain: nociceptive (n = 626; 68.8%); neuropathic (n = 227; 24.9%); incident (n = 329; 36.2%); psychological distress (n = 209; 23%); addictive behavior (n = 51; 5.6%); and normal cognition (n = 639; 70.2%). The frequencies of ECS-CP features and pain intensity scores varied across sites and settings, with more acute settings having higher frequencies of complex pain features. The overall frequency of neuropathic pain was 24.9%, ranging from 11% (hospices) to 34.2% (palliative outpatient clinic) across settings. Multivariate logistic regression analysis revealed that age <60 years, MEDD ≥19 mg, pain intensity ≥7/10, and incident pain were significant independent predictors of neuropathic pain (p < 0.05). Conclusion: The ECS-CP was able to detect salient pain features across settings. Furthermore, the frequencies of neuropathic pain utilizing the NeuPSIG criteria fits within the lower-end of literature estimates (13%-40%). Further research is warranted to validate the NeuPSIG criteria in cancer pain.
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Affiliation(s)
- Mathieos Belayneh
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robin Fainsinger
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Viki Muller
- Covenant Health, Palliative Institute, Network of Excellence in Seniors' Health and Wellness (NESHW), Edmonton, Alberta, Canada
| | - Sylvie Bouchard
- Department of Oncology, Montreal Institute for Palliative Care/Teresa Dellar Palliative Care Residence, McGill University, Montreal, Québec, Canada
| | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lyle Galloway
- Division of Palliative Care, Departments of Oncology and Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Department of Oncology, Alberta Health Services-Cancer Care, University of Alberta, Edmonton, Alberta, Canada
| | - Pippa Hawley
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leonie Herx
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexander Kmet
- Division of Palliative Care, Department of Medicine, University of British Columbia, Whitehorse, Yukon, Canada
| | - Peter Lawlor
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Capela A, Alonso R, Araújo A, Craveiro-Lopes B, Fragoso RM, Mansinho H, Moutinho R, Teixeira JA, Vieira C, Veiga D. [Chemotherapy-Induced Peripheral Neuropathic Pain in Cancer Patients/Survivors]. ACTA MEDICA PORT 2023; 36:77-80. [PMID: 36738187 DOI: 10.20344/amp.18750] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/18/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Andreia Capela
- Serviço de Oncologia Médica. Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia; Associação de Investigação de Cuidados de Suporte em Oncologia. Vila Nova de Gaia. Portugal
| | - Rosário Alonso
- Colégio da Competência em Medicina da Dor. Ordem dos Médicos. Lisboa. Portugal
| | - António Araújo
- Serviço de Oncologia Médica. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. Porto. Portugal
| | | | - Rosa Maria Fragoso
- Serviço de Oncologia Médica e Unidade de Estudo e Tratamento de Dor. Instituto Português de Oncologia do Porto Francisco Gentil. Porto. Portugal
| | - Hélder Mansinho
- Serviço de Hemato-Oncologia Clínica. Hospital Garcia de Orta. Almada. Portugal
| | - Rita Moutinho
- Serviço de Anestesiologia e Unidade Multidisciplinar de Dor. Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | | | - Cláudia Vieira
- Serviço de Oncologia Médica. Instituto Português de Oncologia do Porto Francisco Gentil. Porto; Sociedade Portuguesa de Oncologia. Coimbra. Portugal
| | - Dalila Veiga
- Serviço de Anestesiologia. Unidade Multidisciplinar de Dor Crónica. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. Porto. Portugal
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25
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Tsai JH, Liu IT, Su PF, Huang YT, Chiu GL, Chen YY, Lai WS, Lin PC. Lidocaine transdermal patches reduced pain intensity in neuropathic cancer patients already receiving opioid treatment. Palliat Care 2023; 22:4. [PMID: 36609269 PMCID: PMC9824981 DOI: 10.1186/s12904-023-01126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Limited efficacy has been observed when using opioids to treat neuropathic pain. Lidocaine patches reduce neuropathic pain in postherpetic neuralgia, but their benefits for cancer-related neuropathic pain remain unclear. This study aimed to investigate a treatment for cancer-related neuropathic pain. METHODS We conducted a prospective, open-label, single-arm study to assess the efficacy and safety of lidocaine transdermal patches in patients experiencing localized, superficial, neuropathic cancer pain. Terminal cancer patients already receiving opioid treatment participated in the 3-day study. The primary endpoint was pain intensity evaluated by the numerical rating scale (NRS). The secondary endpoints were the pain relief score and the quality of analgesic treatment. RESULTS The results showed a significant difference in the median NRS over 3 days (Kruskal-Wallis test, p < 0.0001). The median NRS pain intensity from Day 1 to Day 3 was 4.0 with 95% C.I. (3.3, 5.0), 3.0 (2.5, 3.5), and 2.6 (2.0, 3.0), respectively. The difference between the median NRS pain intensities of any 2 days was significant (Wilcoxon signed-rank test, p < 0.0001). The generalized estimating equation (GEE) estimation model showed significant differences between the NRS pain intensities on any 2 days. There was no significant difference in the pain relief score or the quality of analgesic treatment. CONCLUSIONS In this study, the 5% lidocaine transdermal patch reduced the NRS pain intensity in neuropathic cancer patients already receiving opioid treatment. Treatment of localized and superficial neuropathic pain caused by cancer was well tolerated and effective.
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Affiliation(s)
- Jui-Hung Tsai
- grid.412040.30000 0004 0639 0054Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, Taiwan ,grid.412040.30000 0004 0639 0054Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.412040.30000 0004 0639 0054Center for Hospice Palliative Shared Care, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Ting Liu
- grid.412040.30000 0004 0639 0054Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, Taiwan ,grid.412040.30000 0004 0639 0054Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fang Su
- grid.64523.360000 0004 0532 3255Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Tzu Huang
- grid.412040.30000 0004 0639 0054Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, Taiwan ,grid.412040.30000 0004 0639 0054Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ge-Lin Chiu
- grid.412040.30000 0004 0639 0054Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University in Tainan, Tainan, Taiwan
| | - Yu-Yeh Chen
- grid.412040.30000 0004 0639 0054Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University in Tainan, Tainan, Taiwan
| | - Wei-Shu Lai
- grid.412040.30000 0004 0639 0054Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University in Tainan, Tainan, Taiwan ,grid.64523.360000 0004 0532 3255Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Peng-Chan Lin
- grid.412040.30000 0004 0639 0054Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, Taiwan ,grid.412040.30000 0004 0639 0054Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.412040.30000 0004 0639 0054Center for Hospice Palliative Shared Care, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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26
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CASCELLA MARCO, SCHIAVO DANIELA, GRIZZUTI MARIACINZIA, ROMANO MARIACRISTINA, COLUCCIA SERGIO, BIMONTE SABRINA, CUOMO ARTURO. Implementation of a Hybrid Care Model for Telemedicine-based Cancer Pain Management at the Cancer Center of Naples, Italy: A Cohort Study. In Vivo 2023; 37:385-392. [PMID: 36593040 PMCID: PMC9843760 DOI: 10.21873/invivo.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIM Telemedicine, the remote delivery of healthcare services, represents a great opportunity for cancer pain management. A care model of telemedicine that combines remote visits and hospital access could be an effective and safe strategy for pain management of cancer patients. PATIENTS AND METHODS A retrospective study was conducted using the dataset of the telemedicine program at the Istituto Nazionale Tumori of Naples, Italy for assessing the efficacy of a telehealth-based model of care. Demographic, clinical, and process variables were investigated. RESULTS A total of 226 cases and 489 visits were included in the analysis. The mean age of patients was 63.4 years (SD=12.4 years), and no sex differences were observed. Approximately 55% of patients were ECOG-PS ≤2 and 87% suffered from metastatic disease. More than half of the patients were treated with high doses of opioids. Each patient had a mean of 2 remote visits and half of the patients had more than 1 telehealth consultation. The dropout ratio was 5.3%. Most visits (n=472) were conducted on patients in the Campania Region, Italy. The maximum covered distance from the Cancer Center and the patients' location was 555.22 Km. A significant difference in the overall number of visits (p=0.006) and the number of pro-capita remote visits (p=0.010) was found, in favor of the group of patients treated before the end of the Covid-19 emergency in Italy, compared to those treated after the pandemic. CONCLUSION Despite various positive outcomes, the analysis highlights several weaknesses, such as the need to assist patients with advanced and non-advanced disease located outside the regional territory. Overall, the telehealth processes should be adapted to post-pandemic scenarios towards their implementation in routine clinical practice.
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Affiliation(s)
- MARCO CASCELLA
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - DANIELA SCHIAVO
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - MARIACINZIA GRIZZUTI
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - MARIA CRISTINA ROMANO
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - SERGIO COLUCCIA
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - SABRINA BIMONTE
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - ARTURO CUOMO
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
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Upregulation of LncRNA71132 in the spinal cord regulates hypersensitivity in a rat model of bone cancer pain. Pain 2023; 164:180-196. [PMID: 35543644 DOI: 10.1097/j.pain.0000000000002678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/13/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Bone cancer pain (BCP) is a pervasive clinical symptom which impairs the quality life. Long noncoding RNAs (lncRNAs) are enriched in the central nervous system and play indispensable roles in numerous biological processes, while its regulatory function in nociceptive information processing remains elusive. Here, we reported that functional modulatory role of ENSRNOT00000071132 (lncRNA71132) in the BCP process and sponging with miR-143 and its downstream GPR85-dependent signaling cascade. Spinal lncRNA71132 was remarkably increased in the rat model of bone cancer pain. The knockdown of spinal lncRNA71132 reverted BCP behaviors and spinal c-Fos neuronal sensitization. Overexpression of spinal lncRNA71132 in naive rat generated pain behaviors, which were accompanied by increased spinal c-Fos neuronal sensitization. Furthermore, it was found that lncRNA71132 participates in the modulation of BCP by inversely regulating the processing of miR-143-5p. In addition, an increase in expression of spinal lncRNA71132 resulted in the decrease in expression of miR-143 under the BCP state. Finally, it was found that miR-143-5p regulates pain behaviors by targeting GPR85. Overexpression of miR-143-5p in the spinal cord reverted the nociceptive behaviors triggered by BCP, accompanied by a decrease in expression of spinal GPR85 protein, but no influence on expression of gpr85 mRNA. The findings of this study indicate that lncRNA71132 works as a miRNA sponge in miR-143-5p-mediated posttranscriptional modulation of GPR85 expression in BCP. Therefore, epigenetic interventions against lncRNA71132 may potentially work as novel treatment avenues in treating nociceptive hypersensitivity triggered by bone cancer.
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Dupoiron D, Brill S, Eeltink C, Barragán B, Bell D, Petersen G, Eerdekens M, Ryan D, Rakuša M. Diagnosis, management and impact on patients' lives of cancer-related neuropathic pain (CRNP): A European survey. Eur J Cancer Care (Engl) 2022; 31:e13728. [PMID: 36222099 PMCID: PMC9788326 DOI: 10.1111/ecc.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study assessed the impact of cancer-related neuropathic pain (CRNP) on patients and the importance of the patient-healthcare professional (HCP) relationship in diagnosis and management. METHODS A quantitative online survey was conducted involving adult patients from 13 European countries who had been diagnosed with treatable cancer and experienced symptoms of peripheral neuropathy. RESULTS Of 24,733 screened respondents, 549 eligible persons met the inclusion criteria and completed the questionnaire. Among individuals still experiencing pain, 75% rated it as 'severe' or 'moderate'. In addition, 61% reported a negative impact on day-to-day activities, and 30% said they had stopped working as a result. A third of respondents had received no diagnosis of CRNP despite reporting painful symptoms to an HCP. HCPs spending enough time discussing pain and understanding the impact on patients' lives were each associated with an increased likelihood of a formal CRNP diagnosis. Compared with individuals currently in active cancer treatment, cancer survivors were less likely to have a diagnosis of CRNP or regular pain conversations with HCPs. CONCLUSION CRNP remains under-recognised despite its substantial impact on patients' lives. Clinical practice may be improved by strengthening patient-HCP relationships around pain discussions and increasing the focus on pain management among cancer survivors.
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Affiliation(s)
| | - Silviu Brill
- European Pain Federation EFICBrusselsBelgium,Pain InstituteTel Aviv Medical CenterTel AvivIsrael
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Rojo RD, Ren JL, Lipe DN, Badr H, Shete S, Hanna EY, Reyes-Gibby CC. Neuropathic pain prevalence and risk factors in head and neck cancer survivors. Head Neck 2022; 44:2820-2833. [PMID: 36129114 DOI: 10.1002/hed.27199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neuropathic pain (NP) is a debilitating symptom among head and neck cancer (HNC) survivors although few large studies report its prevalence and associated risk factors. METHODS A cross-sectional survey assessing demographic, behavioral, and clinical risk factors for NP. NP was assessed using the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS). RESULTS Forty-five percent (227/505) reported having pain including 13.7% (69/505) who were positive for S-LANSS. Reported pain sites were in the regions of the head and oral cavity (46.2%) and neck and throat (41.5%). Despite a higher self-reported use of analgesic medication (NP+ = 41.2%; NP- = 27.4%; p = 0.020) and alternative pain therapies (NP+ = 19.1%; NP- = 8.4%; p = 0.009), severe pain was more prevalent among those with NP (N+ = 23.2%; NP- = 13.3%; p = 0.004). Adjusted for opioid medications, ethnicity/race, age, surgery, depression, and comorbidities were risk factors for NP. CONCLUSION NP remains prevalent in HNC survivors highlighting the importance of routine pain surveillance.
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Affiliation(s)
- Raniv D Rojo
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Jenny L Ren
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Demis N Lipe
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Hoda Badr
- Baylor College of Medicine, Houston, Texas, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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30
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Yang S, Tan W, Ma X, Qi L, Wang X. Worldwide Productivity and Research Trend of Publications Concerning Cancer-Related Neuropathic Pain: A Bibliometric Study. J Pain Res 2022; 15:2747-2759. [PMID: 36106314 PMCID: PMC9467449 DOI: 10.2147/jpr.s378119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022] Open
Abstract
Cancer-related neuropathic pain is a common adverse effect in the process of cancer development and treatment and has gradually attracted the attention of researchers. The purpose of this article is to systematically review the articles on cancer-related neuropathic pain published between 2012 and 2021 and visualize the data through CiteSpace and R software. The results show that in the past 10 years, a total of 5715 articles have been published, involving 118 categories, of which the most is Clinical Neurology, followed by Neurosciences, Pharmacology Pharmacy. The country with the most published articles is the United States, followed by China and Italy. A total of 22,228 authors were involved in the study of cancer-related neuropathic pain. These historical opinions about cancer-related neuropathic pain could be an important practical basis for further research into potential development trends.
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Affiliation(s)
- Shengjie Yang
- Phase I Clinical Trial Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China
| | - Weijuan Tan
- Phase I Clinical Trial Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China
| | - Xiao Ma
- Department of Surgery Medicine, Zhangqiu People's Hospital, Jinan, 250200, People's Republic of China
| | - Lu Qi
- Phase I Clinical Trial Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China
| | - Xinghe Wang
- Phase I Clinical Trial Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China
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Pérez-Hernández C, Cánovas ML, Carmona-Bayonas A, Escobar Y, Margarit C, Mulero Cervantes JF, Quintanar T, Serrano Alfonso A, Virizuela J. A Delphi Study on the Management of Neuropathic Cancer Pain in Spain: The DOLNEO Study. J Pain Res 2022; 15:2181-2196. [PMID: 35942117 PMCID: PMC9356710 DOI: 10.2147/jpr.s365351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The objectives of this project were to assess the current situation and management of cancer-related neuropathic pain (CRNP) in Spain and to provide specific recommendations for the assessment, diagnosis and treatment of CRNP using a Delphi methodology. Methods This was a qualitative study that followed a Delphi methodology using a questionnaire with 56 statements that were grouped into 5 areas related to CRNP: prevalence and impact, pathophysiology, assessment and diagnosis, specific syndromes, treatment, and multidisciplinary approach. Based on the responses, the scientific committee prepared an algorithm and a recommended pathway for the management of CRNP. Results Seventy-nine physicians attended the meeting and completed the questionnaire. Consensus was reached for all statements relating to the prevalence and impact of CRNP. However, the perceptions of specialists from palliative care of the frequency and impact of CRNP differed from those of other specialists. A high degree of consensus was reached for all statements concerning the assessment and diagnosis of CRNP. Regarding specific syndromes, the only statement with a lack of consensus was that on the frequency of NP in patients undergoing radiotherapy. There were some disagreements regarding the multidisciplinary approach and referral criteria for the management of NP. Conclusion Our results show a large degree of agreement on the assessment, diagnosis and treatment of cancer-related neuropathic pain among the specialists involved in its management. There were, however, some disagreements regarding the multidisciplinary approach and referral criteria for the management of neuropathic pain.
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Affiliation(s)
- Concepción Pérez-Hernández
- Pain Unit, Hospital Universitario de la Princesa, Madrid, Spain
- Correspondence: Concepción Pérez-Hernández, Pain Unit, Hospital Universitario de la Princesa, Calle de Diego de León 62, Madrid, 28006, Spain, Tel +34 915 20 22 00, Email
| | - María Luz Cánovas
- Anesthesia, Complexo Hospitalario Universitario de Ourense (SERGAS), Ourense, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Yolanda Escobar
- Medical Oncology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - César Margarit
- Pain Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Teresa Quintanar
- Medical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - Ancor Serrano Alfonso
- Anesthesiology, Resuscitation and Pain Management, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Virizuela
- Medical Oncology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Ameenudeen S, Kashif M, Banerjee S, Srinivasan H, Pandurangan AK, Waseem M. Cellular and Molecular Machinery of Neuropathic Pain: an Emerging Insight. CURRENT PHARMACOLOGY REPORTS 2022; 8:227-235. [PMID: 35646513 PMCID: PMC9125010 DOI: 10.1007/s40495-022-00294-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review Neuropathic pain (NP) has been ubiquitously characterized by lesion and its linked somatosensory system either the central nervous system (CNS) or peripheral nervous system (PNS) This PNS episode is the most prevalent site of NP origin and is found to be associated with afferent nerve fibers carrying pain signals from injured/trauma site to the CNS including the brain. Several kinds of pharmacotherapeutic drugs shuch as analgesics, anti-convulsants, and anti-depressants are being employed for the its possible interventions. The NP has been a great interest to follow different pathophysiological mechanisms which are often considered to correlate with the metabolic pathways and its mediated disease. There is paucity of knowledge to make such mechanism via NP. Recent Finding Most notably, recent pandemic outbreak of COVID-19 has also been reported in chronic pain mediated diabetes, inflammatory disorders, and cancers. There is an increasing incidence of NP and its complex mechanism has now led to identify the possible investigations of responsible genes and proteins via bioinformatics tools. The analysis might be more instrumental as collecting the genes from pain genetic database, analyzing the variants through differential gene expression (DEG) and constructing the protein–protein interaction (PPI) networks and thereby determining their upregulating and downregulating pathways. Summary This review sheds a bright light towards several mechanisms at both cellular and molecular level, correlation of NP-mediated disease mechanism and possible cell surface biomarkers (receptors), and identified genes could be more promising for their pharmacological targets.
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Affiliation(s)
- Shabnam Ameenudeen
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| | - Mohd. Kashif
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| | - Subhamoy Banerjee
- Department of Basic Science and Humanities, Institute of Engineering and Management, Sector V, Salt Lake, Kolkata, 700091 India
| | - Hemalatha Srinivasan
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| | - Ashok Kumar Pandurangan
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
| | - Mohammad Waseem
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, GST Road, Vandalur, Chennai, 600048 Tamil Nadu India
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Moscato S, Cortelli P, Chiari L. Physiological responses to pain in cancer patients: A systematic review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 217:106682. [PMID: 35172252 DOI: 10.1016/j.cmpb.2022.106682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/23/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Pain is one of the most debilitating symptoms in persons with cancer. Still, its assessment is often neglected both by patients and healthcare professionals. There is increasing interest in conducting pain assessment and monitoring via physiological signals that promise to overcome the limitations of state-of-the-art pain assessment tools. This systematic review aims to evaluate existing experimental studies to identify the most promising methods and results for objectively quantifying cancer patients' pain experience. METHODS Four electronic databases (Pubmed, Compendex, Scopus, Web of Science) were systematically searched for articles published up to October 2020. RESULTS Fourteen studies (528 participants) were included in the review. The selected studies analyzed seven physiological signals. Blood pressure and ECG were the most used signals. Sixteen physiological parameters showed significant changes in association with pain. The studies were fairly consistent in stating that heart rate, the low-frequency to high-frequency component ratio (LF/HF), and systolic blood pressure positively correlate with the pain. CONCLUSIONS Current evidence supports the hypothesis that physiological signals can help objectively quantify, at least in part, cancer patients' pain experience. While there is much more to be done to obtain a reliable pain assessment method, this review takes an essential first step by highlighting issues that should be taken into account in future research: use of a wearable device for pervasive recording in a real-world context, implementation of a big-data approach possibly supported by AI, including multiple stratification factors (e.g., cancer site and stage, source of pain, demographic and psychosocial data), and better-defined recording procedures. Improved methods and algorithms could then become valuable add-ons in taking charge of cancer patients.
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Affiliation(s)
- Serena Moscato
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy.
| | - Pietro Cortelli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, UOC Clinica Neurologica NeuroMet, Ospedale Bellaria, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy; Health Sciences and Technologies, Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
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Lorenzo-Gallego L, Arranz-Martín B, Romay-Barrero H, Prieto-Gómez V, Lluch E, Torres-Lacomba M. Changes in Pain Sensitivity in Treatment for Breast Cancer: A 12-Month Follow-Up Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074055. [PMID: 35409738 PMCID: PMC8998435 DOI: 10.3390/ijerph19074055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022]
Abstract
This study aimed to investigate changes in the pain sensory profile of women with breast cancer. Five women with unilateral breast cancer were enrolled. Participants were assessed with direct (quantitative sensory testing, QST) and indirect measures of pain sensitization (self-reported central sensitization inventory, CSI) at baseline (before surgery), 1 week after surgery, and at 1, 6, 9, and 12 months post-surgery. In the event of pain occurrence, the Leeds Assessment of Neuropathic Symptoms and Signs was also used. Nociceptive pain was the predominant pain mechanism in the postoperative period, while an increase in sensitization predominated one year after breast cancer surgery, especially in those participants who had received more treatment procedures. The participants who received more therapies for breast cancer experienced persistent pain and a higher level of sensitization. An assessment protocol including direct measurements (QST) and indirect measurement (self-reported CSI) allows for detecting changes in pain sensitivity, which can be useful for characterizing and/or predicting pain before, during, and up to one year following surgical interventions for breast cancer.
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Affiliation(s)
- Laura Lorenzo-Gallego
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
| | - Beatriz Arranz-Martín
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
| | - Helena Romay-Barrero
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - Virginia Prieto-Gómez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
- Correspondence:
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain;
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
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Ren JL, Rojo RD, Perez JVD, Yeung SCJ, Hanna EY, Reyes-Gibby CC. Variations in pain prevalence, severity, and analgesic use by duration of survivorship: a cross-sectional study of 505 post-treatment head and neck cancer survivors. BMC Cancer 2021; 21:1304. [PMID: 34872526 PMCID: PMC8650364 DOI: 10.1186/s12885-021-09024-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/10/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Studies suggest a high prevalence of pain in head and neck cancer (HNC) patients at diagnosis, during and after treatment; however, these studies had small sample sizes and did not comprehensively assess factors known to influence pain. We surveyed a large cohort of HNC survivors to determine variations in the prevalence of pain, its treatment and management by duration of survivorship, and assessed a comprehensive list of risk factors. METHODS A cross sectional survey of post-treatment survivors of HNC during routine follow-up clinic visits. RESULTS A total of 505 HNC survivors with a median follow up of 3 years from cancer diagnosis were included in the study. Overall, 45% (n = 224) reported pain and 14.5, 22 and 7% reported use of prescribed pain medication, over-the-counter pain medication and alternative pain therapies, respectively. Prevalence of severe pain was 7.3% and did not vary significantly by years of survivorship (< 1 year = 5.7%; 1 to < 3 years = 7.1%; 3 to < 8 years = 7.6%; 8 years or more =9.7%; P = 0.392). However, use of prescribed pain medication significantly varied by years of survivorship (< 1 year = 45.7%; 1 to < 3 years = 24.6%; 3 to < 8 years = 18.9; 8 years or more = 18.3%; p < 0.001). Of note, a significant proportion of survivors reported moderate to severe pain (moderate to severe = 55.7% versus none to mild = 44.3%) despite step 3 analgesic use (p < 0.001). Multivariable regression shows that recurrent disease (OR 6.77, 95% CI [1.44, 31.80]), history of chemotherapy (OR 6.00, 95% CI [2.10, 17.14]), and depression (Mild-moderate OR 5.30, 95% CI [2.20, 12.78]; Major OR 8.00, 95% CI [2.67, 23.96]) were significant risk factors for severe pain. CONCLUSIONS We identified a high prevalence of pain among HNC survivors and determined that analgesic use varied by the duration of survivorship. Therefore, routine surveillance for pain must be consistent throughout the course of survivorship.
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Affiliation(s)
- Jenny L. Ren
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- Baylor College of Medicine, Houston, TX 77030 USA
| | - Raniv D. Rojo
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- College of Medicine, University of the Philippines Manila, 1000 Manila, Philippines
| | - Joy Vanessa D. Perez
- College of Medicine, University of the Philippines Manila, 1000 Manila, Philippines
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Cielito C. Reyes-Gibby
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
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Sexton M, Garcia JM, Jatoi A, Clark CS, Wallace MS. The Management of Cancer Symptoms and Treatment-Induced Side Effects With Cannabis or Cannabinoids. J Natl Cancer Inst Monogr 2021; 2021:86-98. [PMID: 34850897 DOI: 10.1093/jncimonographs/lgab011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/06/2023] Open
Abstract
Cannabis and cannabinoids are increasingly being accessed and used by patients with advanced cancer for various symptoms and general quality of life. Specific symptoms of pain, nausea and vomiting, loss of appetite and cachexia, anxiety, sleep disturbance, and medical trauma are among those that have prompted patients with cancer to use cannabis. This conference report from the National Cancer Institute's "Cannabis, Cannabinoid and Cancer Research Symposium" on the topic of "Cancer Symptom/Treatment Side Effect Management" is an expert perspective of cannabis intervention for cancer and cancer treatment-related symptoms. The purpose of the symposium was to identify research gaps, describe the need for high-quality randomized prospective studies of medical cannabis for palliative care in patients with cancer, and evaluate the impact of medical cannabis on cancer survivors' quality of life. Further, education of clinicians and affiliated health-care providers in guiding cancer patients in using cannabis for cancer care would benefit patients. Together, these steps will further aid in refining the use of cannabis and cannabinoids for symptom palliation and improve safety and efficacy for patients.
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Affiliation(s)
- Michelle Sexton
- Department of Anesthesiology, Division of Pain Management, University of California, San Diego, CA, USA
| | - Jose M Garcia
- Department of Medicine, Division of Geriatrics, University of Washington and Geriatric Research Education and Clinical Center, Puget Sound Veterans Administration Health Care System, Seattle, WA, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Carey S Clark
- Department of Nursing, Pacific College of Health and Science, San Diego, CA, USA
| | - Mark S Wallace
- Department of Anesthesiology, Division of Pain Management, University of California, San Diego, CA, USA
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Marques RAS, Alencar HS, Bannach MA, Vilela-Filho O. Semidirect targeting-based stereotactic mesencephalotomy for the treatment of refractory pain: a case series. J Neurosurg 2021; 136:1128-1138. [PMID: 34678784 DOI: 10.3171/2021.6.jns21709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE One of the few resources for treating medically intractable pain is ablative surgery, but its indications have fallen dramatically over the last decades. One such procedure is mesencephalotomy. This study aims to determine current risks and benefits of MR-guided semidirect targeting-based stereotactic mesencephalotomy. METHODS This was a retrospective study based on a review of the medical records of 22 patients with nociceptive (n = 5), neuropathic (n = 10), or mixed (n = 7) refractory pain treated with unilateral mesencephalotomy alone (17 patients) or associated with bilateral anterior cingulotomy (5 patients) between 2014 and 2021 in the authors' institutions. The confidence interval adopted in this study was 95%. RESULTS The sample included 12 women and 10 men with ages ranging from 23 to 80 years (mean 55.1 ± 17.1 years). Using MR-guided semidirect targeting, the following structures were targeted: spinoreticulothalamic (neuropathic/mixed pain, n = 17), trigeminothalamic (nociceptive/mixed pain in the face, n = 5), and neospinothalamic (nociceptive/mixed pain in the body, n = 7) pathways. The most common response to macrostimulation was central heat/moderate discomfort. Radiofrequency thermocoagulation was made with 70°C-75°C/60 sec. A total of 86.3% (3 months) and 76.9% (12 months) of the patients achieved excellent or good results (improvement of pain > 50%), presenting with a significant mean pain relief of 80.1% at 3 months and 71.4% at 12 months postoperatively. The addition of bilateral anterior cingulotomy did not improve the results. Patients with upper limb, cervicobrachial, and face pain did significantly better than those with trunk pain. The worst results were seen in patients with neuropathic and/or trunk pain. The surgical failure (pain relief ≤ 25%) and recurrence rates were 9.1% each, apparently related to the use of lower lesioning parameters (70°C/60 sec) and to the presence of neuropathic and/or trunk pain. The morbidity rate was 8%, with both complications (vertical diplopia and confusion/agitation) happening in patients lesioned with 75°C/60 sec. There were no deaths in this series. CONCLUSIONS These results show that contemporary stereotactic mesencephalotomy is an effective, relatively low-risk, and probably underused procedure for treating medically intractable pain. Careful semidirect determination of the target coordinates associated with close attention to electrical macrostimulation responses certainly plays an important role in avoiding complications in most of the procedures. A higher lesioning temperature (75°C) apparently prevents recurrence, but at the cost of an increased risk of complications.
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Affiliation(s)
- Rômulo A S Marques
- 1Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goiás.,2Neurosurgery Service, Araújo Jorge Cancer Hospital; and.,3Department of Neurosurgery, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
| | - Helioenai S Alencar
- 1Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goiás
| | - Matheus A Bannach
- 1Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goiás
| | - Osvaldo Vilela-Filho
- 1Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goiás.,3Department of Neurosurgery, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
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Sørensen J, Sjøgren P, Clemmensen SN, Sørensen TV, Heinecke K, Kurita GP. Improvement of pain management in a comprehensive cancer center: a comparison of two cross-sectional studies 8 years apart. Support Care Cancer 2021; 30:2037-2045. [PMID: 34652549 DOI: 10.1007/s00520-021-06614-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/03/2021] [Indexed: 12/01/2022]
Abstract
CONTEXT In 2011, a multidisciplinary palliative team (MPT) was established at Rigshospitalet (DK) and a cross-sectional study in inpatients was carried out at the Departments of Oncology and Hematology. High symptom burden, high prevalence of pain (64%), and insufficient analgesic treatment were demonstrated. In 2019, a similar study was carried out. OBJECTIVES This study compares prevalence of symptoms including pain and analyzes analgesic treatment of adult in-patients in a comprehensive cancer center. METHODS Two cross-sectional studies (May-Jun 2011; Feb-Sep 2019). INCLUSION CRITERIA malignant diseases, age ≥ 18 y, able to understand Danish. EORTC QLQ-C30 and Brief Pain Inventory (BPI) were applied. RESULTS A total of 134 and 183 inpatients were included in 2011 and 2019, respectively. Differences in the two populations were seen; in 2019 more patients had advanced disease (P = 0.0096), lower performance status (P = 0.0028), and a palliative treatment plan (P = 0.0034). The prevalence of impairments and symptoms was high and similar in the 2 years with exception of severe pain (P = 0.0143) and neuropathic pain (P < 0.0001) which increased in 2019. Moreover, pain relief significantly improved, and significantly fewer patients with pain were left untreated. Significant increase in opioid and adjuvant analgesic prescription in 2019. CONCLUSION An overall unchanged high symptom burden was observed. However, improvement of pain management was observed in 2019. The establishment of a MPT may possibly have contributed to improved pain management.
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Affiliation(s)
- Jonas Sørensen
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
| | - Per Sjøgren
- Palliative Research Group, Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine Novrup Clemmensen
- Department of Hematology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Tanja Vibeke Sørensen
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Katja Heinecke
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Geana Paula Kurita
- Palliative Research Group, Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Brito BE, García MA, De Gouveia YM, Bolaños P, Devis S, Bernal G, Tortorici-Brito VA, Baute L, Díaz-Serrano G, Tortorici V. Concomitant Antihyperalgesic and Antitumor Effects of Gabapentin in a Murine Cancer Pain Model. Int J Mol Sci 2021; 22:ijms22189671. [PMID: 34575835 PMCID: PMC8471802 DOI: 10.3390/ijms22189671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022] Open
Abstract
Cancer pain may be the consequence of physical nerve compression by a growing tumor. We employed a murine model to study whether gabapentin was able to regulate tumor growth, in addition to controlling hyperalgesic symptoms. A fluorescent melanoma cell line (B16-BL6/Zs green) was inoculated into the proximity of the sciatic nerve in male C57BL/6 mice. The tumor gradually compressed the nerve, causing hypersensitivity. Tumor growth was characterized via in vivo imaging techniques. Every other day, gabapentin (100 mg/Kg) or saline was IP administered to each animal. In the therapeutic protocol, gabapentin was administered once the tumor had induced increased nociception. In the preventive protocol, gabapentin was administered before the appearance of the positive signs. Additionally, in vitro experiments were performed to determine gabapentin's effects on cell-line proliferation, the secretion of the chemokine CCL2, and calcium influx. In the therapeutically treated animals, baseline responses to noxious stimuli were recovered, and tumors were significantly reduced. Similarly, gabapentin reduced tumor growth during the preventive treatment, but a relapse was noticed when the administration stopped. Gabapentin also inhibited cell proliferation, the secretion of CCL2, and calcium influx. These results suggest that gabapentin might represent a multivalent strategy to control cancer-associated events in painful tumors.
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Affiliation(s)
- Beatriz Elena Brito
- Laboratorio de Patología Celular y Molecular, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (B.E.B.); (M.A.G.); (Y.M.D.G.); (G.B.); (V.A.T.-B.); (L.B.)
| | - María Alejandra García
- Laboratorio de Patología Celular y Molecular, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (B.E.B.); (M.A.G.); (Y.M.D.G.); (G.B.); (V.A.T.-B.); (L.B.)
| | - Yetsenia María De Gouveia
- Laboratorio de Patología Celular y Molecular, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (B.E.B.); (M.A.G.); (Y.M.D.G.); (G.B.); (V.A.T.-B.); (L.B.)
| | - Pura Bolaños
- Laboratorio de Fisiología Celular, Centro de Biofísica y Bioquímica, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela;
| | - Sindy Devis
- Laboratorio de Neurofisiología, Centro de Biofísica y Bioquímica, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (S.D.); (G.D.-S.)
| | - Geraldinee Bernal
- Laboratorio de Patología Celular y Molecular, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (B.E.B.); (M.A.G.); (Y.M.D.G.); (G.B.); (V.A.T.-B.); (L.B.)
| | - Víctor Alejandro Tortorici-Brito
- Laboratorio de Patología Celular y Molecular, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (B.E.B.); (M.A.G.); (Y.M.D.G.); (G.B.); (V.A.T.-B.); (L.B.)
| | - Leslie Baute
- Laboratorio de Patología Celular y Molecular, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (B.E.B.); (M.A.G.); (Y.M.D.G.); (G.B.); (V.A.T.-B.); (L.B.)
| | - Gabriel Díaz-Serrano
- Laboratorio de Neurofisiología, Centro de Biofísica y Bioquímica, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (S.D.); (G.D.-S.)
| | - Víctor Tortorici
- Laboratorio de Neurofisiología, Centro de Biofísica y Bioquímica, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela; (S.D.); (G.D.-S.)
- Laboratorio de Neurociencia, Departamento de Ciencias del Comportamiento, Escuela de Psicología, Universidad Metropolitana (UNIMET), Caracas 1073, Venezuela
- Correspondence: ; Tel.: +58-(212)-240-3788
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Baek SK, Shin SW, Koh SJ, Kim JH, Kim HJ, Shim BY, Kang SY, Bae SB, Yun HJ, Sym SJ, Han HS, Gil HY. Significance of descriptive symptoms and signs and clinical parameters as predictors of neuropathic cancer pain. PLoS One 2021; 16:e0252781. [PMID: 34403429 PMCID: PMC8370612 DOI: 10.1371/journal.pone.0252781] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Evaluation of symptoms and signs for the management of neuropathic cancer pain (NCP) is challenging. This study aimed to identify clinical predictors of NCP and symptoms and signs most relevant of those in Korean patients. Methods This nationwide, descriptive, cross-sectional, multicenter, observational study included 2,003 cancer patients aged ≥20 years who reported a visual analog scale (VAS) score ≥1 for pain and provided informed consent for participation. The Douleur Neuropathic (DN4) questionnaire (score ≥4) was used to determine symptoms and signs as well as the presence of NCP. Results The prevalence of NCP was associated with age <65 years [OR, 1.57; 95% CI, 1.270–1.934], disease duration >6 months (OR, 1.57; 95% CI, 1.232–2.012), stage IV cancer (OR, 0.75; 95% CI, 0.593–0.955), history of chemotherapy (OR, 1.74; 95% CI, 1.225–2.472), and moderate-to-severe cancer pain (OR, 2.05; 95% CI, 1.671–2.524) after multivariate analysis. The most common descriptive symptoms of NCP were tingling, electric shock, and pins and needles. For NCP patients in the presence or absence of the clinical predictors, pins and needles (p = 0.001) and painful cold (p<0.001) symptoms were significantly frequent in patients with moderate-to-severe pain. Tingling, numbness, and touch hypoesthesia (p = 0.022, 0.033, 0.024, respectively) were more frequent in those with longer cancer duration and hyperesthesia (p = 0.024) was more frequent in young patients. Conclusion Age <65 years, disease duration >6 months, stage IV cancer, history of chemotherapy, and moderate-to-severe cancer pain, were identified as predictors of NCP. Some symptoms and signs of NCP were associated with these predictors. Further studies are warranted on the pathogenesis and management of NCP with respect to the symptoms and signs, and factors associated with pain severity in Korean patients.
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Affiliation(s)
- Sun Kyung Baek
- Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Sang Won Shin
- Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
| | - Su-Jin Koh
- Department of Hematology-Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
| | - Jung Han Kim
- Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyo Jung Kim
- Internal Medicine, Hallym University Sacred Heart Hospital Anyang, Anyang, South Korea
| | - Byoung Yong Shim
- Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Sang Byung Bae
- Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Hwan Jung Yun
- Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Sun Jin Sym
- Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Ha Yeong Gil
- Medical Affairs, Internal Medicine, Pfizer Pharmaceuticals Korea Ltd., Seoul, South Korea
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Wu CJ, Huang KJ, Tsai YC, Yeh TP, Hsieh CF, Wang YJ. Peripheral Neuropathy: Comparison of Symptoms and Severity Between Colorectal Cancer Survivors and Patients With Diabetes. Clin J Oncol Nurs 2021; 25:395-403. [PMID: 34269355 DOI: 10.1188/21.cjon.395-403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripheral neuropathy (PN) is a common symptom in colorectal cancer (CRC) survivors and patients with diabetes. However, the differences in PN symptoms between CRC survivors and patients with diabetes are not clear. OBJECTIVES The purpose of this study was to examine the differences in PN between CRC survivors and patients with diabetes. METHODS Secondary data were analyzed from two cross-sectional studies consisting of 81 CRC survivors and 86 patients with diabetes from two hospitals in northern and central Taiwan. Data were analyzed using descriptive statistics, analysis of covariance, and multiple logistic regression. FINDINGS Significant differences in severity and prevalence of PN and neuropathic pain between CRC survivors and patients with diabetes were found. Patients with diabetes had significantly more severe PN and sensory PN compared to CRC survivors. In addition, the prevalence of PN and neuropathic pain was significantly higher in CRC survivors compared to patients with diabetes after control of covariates.
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Affiliation(s)
| | | | - Yi-Chuan Tsai
- Christian Medical Foundation Lukang Christian Hospital
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42
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Amano K, Ishiki H, Miura T, Maeda I, Hatano Y, Oyamada S, Yokomichi N, Tagami K, Odagiri T, Ito T, Baba M, Morita T, Mori M. C-Reactive Protein and Its Relationship with Pain in Patients with Advanced Cancer Cachexia: Secondary Cross-Sectional Analysis of a Multicenter Prospective Cohort Study. Palliat Med Rep 2021; 2:122-131. [PMID: 34223511 PMCID: PMC8241396 DOI: 10.1089/pmr.2021.0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Limited information is available on the relationship between C-reactive protein (CRP) levels and pain in advanced cancer. Objectives: To investigate the relationship between serum levels of CRP and subtypes of pain. Design: A secondary cross-sectional analysis of a prospective cohort study. Setting/Subjects: Patients with advanced cancer admitted to 23 palliative care units in Japan. Measurements: Patients rated the severity of pain on the numerical rating scale (NRS) and physicians evaluated pain on the integrated palliative care outcome scale (IPOS). Physicians assessed neuropathic pain and breakthrough pain based on their presence or absence. Patients were divided into four groups according to CRP levels. Comparisons were performed using the Kruskal–Wallis test or chi-squared test. To evaluate the relationship between CRP and subtypes of pain, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in logistic models were calculated. Results: We divided 1513 patients into four groups: low CRP (n = 234), moderate CRP (n = 513), high CRP (n = 352), and very high CRP (n = 414). Spearman's correlation coefficient between CRP and pain NRS and that between CRP and pain IPOS were 0.15 (p < 0.001) and 0.16 (p < 0.001), respectively. In the models of pain NRS and pain IPOS, significantly higher adjusted ORs than in the low CRP group were observed in the very high CRP group (1.81 [95% CI 1.14–2.88], p = 0.01; 1.74 [95% CI 1.18–2.57], p = 0.005, respectively). Relationships were not observed between CRP, neuropathic pain, and breakthrough pain. Conclusions: The results indicated direct relationships between CRP, pain NRS, and pain IPOS.
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Affiliation(s)
- Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Toyonaka, Osaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Shunsuke Oyamada
- Department of Biostatistics, JORTC Data Center, Arakawa-ku, Tokyo, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Tetsuya Ito
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Mika Baba
- Department of Palliative Medicine, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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Patel AA, Zhukosvky M, Sidharthan S, Jotwani R, Rakesh N, Gulati A. Preliminary effects of low-intensity focused ultrasound treatment program for cancer-related neuropathic pain. Pain Manag 2021; 11:613-621. [PMID: 34102872 DOI: 10.2217/pmt-2020-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the effectiveness of low-intensity focused ultrasound (LIFU) therapy in the management of cancer-related neuropathic pain (CNP). Methods: A retrospective review with 22 patients with CNP treated with LIFU therapy (frequency 3 Hz, 3 W/cm2, pulse mode duty cycle 50%) was conducted. Results: Out of the 22 patients, 15 had CNP secondary to chemotherapy-induced peripheral neuropathy. Compared with baseline, there was a significant reduction in numeric pain rating scale (p < 0.001). Additionally, 76.5% of patients (n = 13) were considered to be responders to LIFU therapy. Conclusion: LIFU therapy may be a viable treatment modality in the management of CNP, specifically chemotherapy-induced peripheral neuropathy, with a minimal side effect profile. Larger, prospective studies with a structured protocol are necessary.
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Affiliation(s)
- Ankur A Patel
- Department of Physical Medicine & Rehabilitation, New York-Presbyterian Hospital/Columbia University Vagelos College of Physicians & Surgeons & Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Max Zhukosvky
- Department of Anesthesiology, New York-Presbyterian/Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Shawn Sidharthan
- Department of Neurology, North Shore - Long Island Jewish Health System, Manhasset, NY 11030, USA
| | - Rohan Jotwani
- Department of Anesthesiology, New York-Presbyterian/Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Neal Rakesh
- Weill Cornell Tri-Institutional Pain Medicine Program, Department of Anesthesiology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Amitabh Gulati
- Department of Anesthesiology & Critical Care, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Borges JP, Mekhail K, Fairn GD, Antonescu CN, Steinberg BE. Modulation of Pathological Pain by Epidermal Growth Factor Receptor. Front Pharmacol 2021; 12:642820. [PMID: 34054523 PMCID: PMC8149758 DOI: 10.3389/fphar.2021.642820] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/26/2021] [Indexed: 12/18/2022] Open
Abstract
Chronic pain has been widely recognized as a major public health problem that impacts multiple aspects of patient quality of life. Unfortunately, chronic pain is often resistant to conventional analgesics, which are further limited by their various side effects. New therapeutic strategies and targets are needed to better serve the millions of people suffering from this devastating disease. To this end, recent clinical and preclinical studies have implicated the epidermal growth factor receptor signaling pathway in chronic pain states. EGFR is one of four members of the ErbB family of receptor tyrosine kinases that have key roles in development and the progression of many cancers. EGFR functions by activating many intracellular signaling pathways following binding of various ligands to the receptor. Several of these signaling pathways, such as phosphatidylinositol 3-kinase, are known mediators of pain. EGFR inhibitors are known for their use as cancer therapeutics but given recent evidence in pilot clinical and preclinical investigations, may have clinical use for treating chronic pain. Here, we review the clinical and preclinical evidence implicating EGFR in pathological pain states and provide an overview of EGFR signaling highlighting how EGFR and its ligands drive pain hypersensitivity and interact with important pain pathways such as the opioid system.
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Affiliation(s)
- Jazlyn P Borges
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Katrina Mekhail
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Gregory D Fairn
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Biochemistry, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Chemistry and Biology, Ryerson University, Toronto, ON, Canada
| | - Costin N Antonescu
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Chemistry and Biology, Ryerson University, Toronto, ON, Canada
| | - Benjamin E Steinberg
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
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Maihöfner C, Diel I, Tesch H, Quandel T, Baron R. Chemotherapy-induced peripheral neuropathy (CIPN): current therapies and topical treatment option with high-concentration capsaicin. Support Care Cancer 2021; 29:4223-4238. [PMID: 33624117 PMCID: PMC8236465 DOI: 10.1007/s00520-021-06042-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022]
Abstract
Cancer diagnosis and treatment are drastic events for patients and their families. Besides psychological aspects of the disease, patients are often affected by severe side effects related to the cancer itself or as a result of therapeutic interventions. Particularly, chemotherapy-induced peripheral neuropathy (CIPN) is the most prevalent neurological complication of oral or intravenous chemotherapy. The disorder may require dose reduction of chemotherapy and is accompanied by multiple symptoms with long-term functional impairment affecting quality of life (QoL), e.g., sensory and functional deteriorations as well as severe pain. Although CIPN may reverse or improve after termination of the causative chemotherapy, approximately 30–40% of patients are faced with chronicity of the symptoms. Due to the advantages in cancer diagnosis and treatments, survival rates of cancer patients rise and CIPN may occur even more frequently in the future. In this review, we summarize current recommendations of leading national and international societies regarding prevention and treatment options in CIPN. A special focus will be placed on current evidence for topical treatment of CIPN with high-dose capsaicin. Finally, an algorithm for CIPN treatment in clinical practice is provided, including both pharmacologic and non-pharmacologic modalities based on the clinical presentation.
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Affiliation(s)
- Christian Maihöfner
- Department of Neurology, Fürth General Hospital, Jakob-Henle-Straße 1, 90766, Fürth, Germany.
| | - Ingo Diel
- Praxisklinik Am Rosengarten, Mannheim, Germany
| | - Hans Tesch
- Department of Oncology, Bethanien Hospital, Frankfurt am Main, Germany
| | | | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Balkrishna A, Sakat SS, Karumuri S, Singh H, Tomer M, Kumar A, Sharma N, Nain P, Haldar S, Varshney A. Herbal Decoction Divya-Peedantak-Kwath Alleviates Allodynia and Hyperalgesia in Mice Model of Chemotherapy-Induced Peripheral Neuropathy via Modulation in Cytokine Response. Front Pharmacol 2020; 11:566490. [PMID: 33324205 PMCID: PMC7723448 DOI: 10.3389/fphar.2020.566490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
The widely used cancer treatment, chemotherapy, causes severe long-term neuropathic pain in 30–40% cases, the condition clinically known as chemotherapy-induced peripheral neuropathy (CIPN). Approved conventional analgesics are sometimes ineffective, while others like opioids have undesirable side effects like addiction, seizures, and respiratory malfunctioning. Tricyclic antidepressants and anticonvulsants, although exhibit anti-allodynic effects in neuropathy, also have unpleasant side effects. Thus, alternative medicines are being explored for CIPN treatment. Despite scattered reports on different extracts from different plants having potential anti-allodynic effects against CIPN, no established medicine or formulation of herbal origin exists. In this study, efficacy of an herbal decoction, formulated based on ancient medicinal principles and protocols for treating neuropathic pain, Divya-Peedantak-Kwath (DPK), has been evaluated in a paclitaxel (PTX)-induced peripheral neuropathic mouse model. We observed that DPK has prominent anti-allodynic and anti-hyperalgesic effects and acts as a nociceptive modulator for CIPN. With exhibited antioxidative effects, DPK restored the redox potential of the sciatic nerves to the normal. On histopathological evaluation, DPK prevented the PTX-induced lesions in the sciatic nerve, in a dose-dependent manner. It also prevented inflammation by modulating the levels of pro-inflammatory cytokines involved in CIPN pathogenesis. Our observations evinced that DPK can alleviate CIPN by attenuating oxidative stress and concomitant neuroinflammation through immune modulation.
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Affiliation(s)
- Acharya Balkrishna
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India.,Department of Allied and Applied Sciences, University of Patanjali, Haridwar, India
| | - Sachin S Sakat
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India
| | - Shadrak Karumuri
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India
| | - Hoshiyar Singh
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India
| | - Meenu Tomer
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India
| | - Ajay Kumar
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India
| | - Niti Sharma
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India
| | - Pradeep Nain
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India
| | - Swati Haldar
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India
| | - Anurag Varshney
- Drug Discovery and Development Division, Patanjali Research Institute, Haridwar, India.,Department of Allied and Applied Sciences, University of Patanjali, Haridwar, India
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Ismy J, Emril DR, Rizkidawati. Management of cancer pain with analgetic adjuvant and weak opioid in prostate cancer bone metastases: A case series. Ann Med Surg (Lond) 2020; 60:575-578. [PMID: 33299563 PMCID: PMC7701877 DOI: 10.1016/j.amsu.2020.10.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In cancer patients, cancer pain is the most common cancer complication. About 60-90% of patients with advanced stage cancer experience various levels of pain, and about 30% of patients have been suffering from persistent severe pain. Bones are the most frequent targets of metastases in patients with cancer such as breast, prostate, lung, kidney, and thyroid. In advanced prostate cancer, bone metastasis leads to bone pain, skeletal fracture, and increased mortality. At least 75% of patients with bone metastasis experience bone pain. CASE DESCRIPTION We report three cases of cancer pain, treated with primary cancer from the prostate metastasis to the spine. All three patients had lower back pain that radiated to the left and right limbs, with mixed pain and bone pain, where early hospital admission shows the Numeric Rating Scale (NRS) pain scale 9-10. Treated with administration of adjuvant therapy (Gabapentin) and weak opioids (injections of Tramadol) as well as injections of Metylprednisolone (for 3 days), the patient's pain scale was evaluated, and the average NRS obtained on days 2-4 was 5-6. On day 5-8, treatment continued with Gabapentin and Tramadol injections, and the pain scale (NRS) decreased to 2-3. All patients on the 8-9th day of treatment also received Biphosphonates to reduce pain, bone damage, fracture risk, and blood calcium levels. Patients can be discharged with an oral Gabapentin prescription only. CONCLUSION A pain scale (NRS) reduction of >50% is obtained from the initial pain scale in cancer pain patients treated using a combination of adjuvant therapy and weak opioids.
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Affiliation(s)
- Jufriady Ismy
- Urology Division, Surgery Department, Faculty of Medicine, Universitas Syiah Kuala, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
| | - Dessy Rakhmawati Emril
- Pain and Headache Division, Neurology Department, Faculty of Medicine, Universitas Syiah Kuala, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
| | - Rizkidawati
- Pain and Headache Division, Neurology Department, Faculty of Medicine, Universitas Syiah Kuala, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
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Quintero-Carreño V, Margarita-Molina B, Rodríguez-Martínez CH. Spinal cord stimulation in the management of neuropathic pain in cancer patients: case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Neuropathic pain is present in up to 40 % of all cancer patients. A considerable number of patients fail to achieve enough pain relief with conventional treatment, which is why therapeutic alternatives such as spinal cord stimulation should be considered.
Case description and results: This is the case of a female patient with chronic neuropathic pain secondary to a partial femoral nerve injury sustained during resection and lymph node dissection surgery with curative intent for a large stage II cell squamous cell carcinoma T2N0M0, localized in the right popliteal fossa. The patient presented with difficult to manage chronic neuropathic pain, despite receiving multiple oral analgesics and nerve blocks. A medullary neurostimulator was implanted that relieved the patient’s pain intensity in up to 80%, in addition to improved function and quality of life.
Conclusions: spinal cord stimulation is considered an effective neuromodulatory intervention which has shown satisfactory results in the treatment of various types of refractory chronic pain in cancer patients, including neuropathic pain.
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Factors influencing physical activity in patients with colorectal cancer. Ir J Med Sci 2020; 190:539-546. [PMID: 32772301 DOI: 10.1007/s11845-020-02338-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Physical activity (PA) is a modifiable health behaviour in patients with colorectal cancer (CRC). Knowing the possible predictors of PA will contribute to producing physical and psychological benefits for CRC patients. OBJECTIVE To investigate the factors that influence PA in patients with CRC. METHODS This cross-sectional study was conducted with 47 participants with CRC. Demographic and clinical characteristics, neuropathic pain (Douleur Neuropathique 4 (DN4)), peripheral muscle strength (knee extensor and flexor, hip extensor and flexor, and ankle dorsiflexor muscle strength), balance (Balance Master System (BMS) and Berg Balance Scale (BBS)), fatigue (Brief Fatigue Inventory (BFI)), PA (International PA Questionnaire Short Form (IPAQ-SF)), and quality of life (36-item Short Form Health Survey (SF-36)) were evaluated. Multiple linear regression analysis was used to determine the variables that have the greatest influence on PA. RESULTS IPAQ-SF score had moderate correlations with knee extensor muscle strength (r = 0.310, p = 0.034), BBS (r = 0.361, p = 0.013), and limit of stability test (movement velocity) score (r = 0.385, p = 0.008), BFI- severity of fatigue (r = - 0.488, p = 0.001), impact of fatigue on daily functioning (r = - 0.421, p = 0.003), and the SF-36 sub-parameters (role limitations due to physical health problems, physical functioning, general health perceptions and vitality) (p < 0.05). Role limitations due to physical problems, knee extensor muscle strength, and severity of fatigue had the greatest influence on PA in patients with CRC with explaining 43% of the variance in PA. CONCLUSIONS This study suggests that quality of life, knee extensor muscle strength, and fatigue have the greatest influence on PA in patients with CRC.
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Phạm TL, Kim DW. Poly(lactic-co-glycolic acid) nanomaterial-based treatment options for pain management: a review. Nanomedicine (Lond) 2020; 15:1897-1913. [PMID: 32757701 DOI: 10.2217/nnm-2020-0114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neuropathic pain is one of the most intense types of chronic pain; it constitutes a pervasive complaint throughout the public health system. With few effective treatments, it remains a significant challenge. Commercially available drugs for neuropathic pain are still limited and have disappointing efficacy. Therefore, chronic neuropathic pain imposes a tremendous burden on patients' quality of life. Recently, the introduction and application of nanotechnology in multiple fields has accelerated the development of new drugs. This review highlights the application of poly(lactic-co-glycolic acid) nanomaterial-based vehicles for drug delivery and how they improve the therapeutic outcomes for neuropathic pain treatment. Finally, future developments for pain research and effective management are presented.
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Affiliation(s)
- Thuỳ Linh Phạm
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
- Department of Anatomy, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
- Department of Histology & Embryology, Hai Phong University of Medicine & Pharmacy Hospital, Hai Phong, 042-12, Vietnam
| | - Dong Woon Kim
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
- Department of Anatomy, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
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